The European Union (EU) and the world are faced with unprecedented economic challenges, which if allowed to persist could threaten its continued existence in its current form as a union. Furthermore, these same financial challenges can easily translate into societal hardship. The biomedical and pharmaceutical industries of the U.S. and Europe have been in the midst of severe financial constraints over the last few years, which will worsen in the coming years. A critical factor is a financial crisis that appears to be spreading like wildfire through Europe, with 3 of its oldest members (Greece, Ireland, Portugal) already having enlisted the aid of the International Monetary Fund (IMF) to avoid bankruptcy, and with the possibility of others to follow (Italy, Spain). Adding to this the increasing cost of introducing new medications and devices, and conducting clinical research, as well as the tightening regulatory pressures and the drying pharmaceutical pipelines, cost cutting pressures are mounting on pharmaceutical industries and the biomedical sector, whether in academia or in industry. This paper will attempt to highlight some of the problems that clinical research in Europe may be facing, as well as discuss some of the potential solutions. Although this will by no means be an exhaustive analysis, the goal is to show that times of financial hardship, such as the current one, may also provide the impetus for constructive change.

Aim: The aim of the study is to evaluate the data of cases who were 65 years and older among cancer records from the data of Izmir Cancer Registry (ICR), in Izmir Ataturk Research Training Hospital (IAEAH), according to topography, histology, sex and having multiple tumors and to compare them with the data of cases younger than 65 years.Material and Methods: Twenty thousands eight hundred and thirty (20,830) cases (7148 cases are ≥65 years) recorded during the period of 1993-2005 by office of ICR, located in IAEAH, were analyzed. Assessment of data was carried out by SPSS 10.0 for Windows package program. For statistical analysis Pearson's Chi-Square Test and Yates 'ecorrections were performed.Results: Of 20,830 cases with cancer, recorded in the hospital data-base during 1993-2005, 34.3% were diagnosed at the age of 65 years and older. The most frequent tumor localizations in the cases younger than 65 years were breast, larynx, digestive system, skin and hematopoietic-reticuloendothelial system whereas the tumors in the, skin, digestive system and the urogenital system were more common in cases older than 65 years. When histological diagnoses were taken into consideration, basal cell carcinomas and squamous and transitional cell carcinoma were seen more frequent in the group of cases 65 years or older. The incidence of synchronous and metachronous tumors were not different in the cases younger or older than 65 years.Conclusion: There is a strong need to establish a communication between national and international database systems, which would yield an opportunity in the comparison of the incidence of the diseases.

The most frequent and probably the earliest described surgical intervention of ENT field is tonsillectomy. Various methods were described and devices were invented up to now in order to increase safety and decrease time consumption and complications. All new created devices promises lower intraoperative blood loss, intraoperative time, postoperative pain and bleeding. But with their widely use it is seen that they cannot fulfill what they promise. Debate also continues as to which technique yields the best outcome. This study reports a summary for common medical devices which were previously used in tonsillectomy.

Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality with increasing rates during the last decades. Due to the progressive nature of the disease, underestimation of symptoms by the patients, lack of knowledge and underuse of spirometry by the Primary Care providers the disease remains under-diagnosed in about half of the cases. Patients with a smoking history of ≥20 pack-years and relevant symptoms (e.g. dyspnea, chronic cough and sputum production) are considered a high risk group. Measurement of spirometric parameters after administration of a short acting bronchodilator confirms the presence of irreversible airflow obstruction and establishes the diagnosis. However in the primary care spirometry is usually not available and differential diagnosis with other obstructive pulmonary diseases (e.g. asthma, bronchiectasis) is not always easy. General Practitioners (GPs) need simple screening tools to decide if a patient belong to a high risk group and pulmonary consultation is necessary. Early and accurate diagnosis of COPD in the primary care setting allowing for a timely and effective management which reduces the rate of decline in lung function improves survival of patients, their quality of life and reduces health-care utilization. The aim of the present review is to provide the existing information about COPD diagnosis and the related problems in the Primary Care. Also we reviewed numerous simple COPD diagnosis questionnaires as well as the use of hand-held flow meters which could be used as effective screening tools.

Background and Aim: Pancreaticoduodenectomy (PD) is considered to be the optimal treatment for carcinoma of the ampulla of Vater, but the trauma caused by PD is often severe and extensive. Local resection (LR) for ampullary tumors has been performed for a century but remains controversial. The use of this procedure for benign conditions is clear, but its place, if any, in the management of ampullary carcinoma is debated. The aim of this study was to investigate the outcomes and analyse the prognostic factors of LR of carcinoma of the ampulla of Vater by comparison with PD.Patients and Methods: A retrospective analysis of 71 patients of carcinoma of the ampulla of Vater was conducted at Zhejiang Cancer Hospital from January 1995 to December 2005. We investigated the differences of the baseline characteristics and the intra- and postoperative data of patients who underwent PD and LR. Prognostic factors for recurrence and survival of carcinoma of the ampulla of Vater between PD and LR was also analysed.Results: Among the 71 patients of ampullary carcinoma who underwent surgical resection, a PD was performed in 46 (64.8%) patients while a LR was performed in 25 (35.2%) patients. The 30-day mortality rate associated with PD (6.5%) was not different from that with LR (0%; p=0.547) while the morbidity following PD (30.4%) and LR (8.0%) was statistically different (p=0.031). The complications were also significantly higher in the PD group than the LR group (34.8% vs 6.5%; p=0.013). In a univariate Cox regression analysis of survival, there were significant differences in tumor size (p=0.031), TNM (Tumor Node Metastasis) stage (p=0.000), pT (pathologic Tumor) stage (p=0.010), pN (pathologic Node) stage (p=0.000), differentiation (p=0.026), and surgical margin (p=0.031). Multivariate Cox regression analysis showed that TNM stage (HR=3.640, 95% CI 1.428~9.282; p=0.007), pT stage (HR=3.090, 95% CI 1.230~7.762; p=0.016), and pN stage (HR=4.479, 95% CI 1.524~013.161; p=0.005) remained as independent predictors of survival rates. According to the method of Kaplan-Meier, the five-year survival rate in the PD group was 53.5% and that in the LR group was 48.0%, no significant differences were found between the two groups in overall survival rates (p=0.540). Compared with the PD, the 5-year survival of patients with the TNM stage-III/IV who undergoing LR was statistically lower (11.1% vs 38.1%; p=0.040). As expected, the overall survival were signicant differences between the two groups in pT stage-T3/T4 (47.4% vs 18.2%, p=0.018) and pN stage-N1 (36.8% vs 11.1%, p=0.004), respectively. Tumor recurrence was diagnosed in 10/43 (23.3%) patients after PD and 12/25 (48.0%) patients after LR (p=0.035). Logistic regression analysis of recurrence showed that TNM stage-III/IV (p=0.004), pT stage-T3/T4 (p=0.034), and pN stage-N1 (p=0.007) were associated with a 2.444, 1.943, and 2.111-fold increased risk of recurrence, respectively.Conclusions: PD is the preferred operation for carcinoma of the ampulla of Vater. LR is less mortal and morbid than PD, which is a suitable treatment in patients with a low-risk cancer in stages I/II or pT1/T2 N0 with a maximum diameter of 2 cm or less. TNM stage, pT stage, and pN stage remained as independent predictors of survival rates.

Background: There is limited data on dermoscopic features of basal cell carcinomas (BCCs). We evaluated the presence of dermoscopic features in superficial (sBCCs), nodular (nBCCs), pigmented and non-pigmented BCCs in order to evaluate the role of dermoscopy in the diagnosis of different subtypes of BCCs.Patients and Methods: We conducted a retrospective study to evaluate the presence of dermoscopic features in superficial, nodular, pigmented and non - pigmented BCCs. One hundred thirty eight lesions (42 superficial, 96 nodular, 102 pigmented and 36 non-pigmented) were assessed by dermoscopy.Results: The most significant features in all categories, were a scattered vascular pattern, featureless areas, atypical red vessels, arborizing vessels, comma vessels, background of white-red structureless areas and telangiectasias. Haemorrhage-ulceration, hypopigmented areas and blue-grey ovoid nests were all more likely to be observed in sBCCs, than in nBCCs (p < 0.0001). Arborizing and atypical red vessels in addition to featureless areas, were more frequent in nodular than in sBCCs (p < 0.0001). Telangectasias, white-red structureless areas, red dots and red globules were more common in non- pigmented than in pigmented BCCs (p < 0.0001). In addition, a significant difference of arborizing vessels was detected in pigmented lesions in comparison to non-pigmented (p < 0.0001).Conclusions: Dermoscopic hallmarks of all BCCs may be the scattered atypical vessels, featureless areas and the whitered structureless background. Superficial BCCs are also characterized by comma vessels, haemorrhage, small ulcerations, hypopigmented areas, telangiectasias and blue-gray ovoid nests while nBCCs by arborizing vessels. Dermoscopy was found to be a valuable tool for the diagnosis of specific subtypes of BCCs.

Background: Ablative radioiodine-131 (¹³¹I) therapy is used in the standart treatment procedure of thyroid carcinoma and procedures using ¹³¹I represent the majority of Nuclear Medicine therapeutic procedures. The principal route of ¹³¹I excretion after the administration of ¹³¹I is the urine. Amifostine is an organic thiophosphate ester prodrug and the kidney concentrations of the active metabolite WR-1065 are about 100 times higher than tumour concentrations. To our knowledge, there is no published data in literature presenting acute effect of radioiodine on renal tissue during high dose I-131 radioiodine treatment (RIT). Additionally, it is not known whether amifostine takes role in this process.Materials and methods: In this study, 50 healthy female Wistar albino rats, weighing 200-250 g and averaging 16 weeks old were utilised. The rats were randomly divided into ten groups. 1- Sham group (n=5), 2- Amifostine group (n=5): rats pretreated with 1 cc amifostine (200 mg/kg) by intraperitoneal injection, 3- Radioactive iodine first day group (RI-1) (n=5): rats treated with 1 cc oral 185 MBq radioactive iodine-131 and sacrification performed after 1st day, 4- Amifostine + Radioactive iodine first day group (A+RI-1) (n=5): rats pretreated with amifostine (200 mg/kg) by intraperitoneal injection and rats treated with 5mCi radioactive iodine-131 and sacrification performed after 1st day. 5- Radioactive iodine third day group (RI-3) (n=5), 6- Amifostine + Radioactive iodine third day group (A+RI-3) (n=5), 7- Radioactive iodine fifth day group (RI-5) (n=5), 8- Amifostine + Radioactive iodine fifth day group (A+RI-5) (n=5), 9- Radioactive iodine seventh day group (RI-7) (n=5) and 10- Amifostine + Radioactive iodine seventh day group (A+RI-7) (n=5). The renal cast formation and tubular damage are evaluated by a pathologist in a blinded manner.Results: Ablative radioiodine-131 therapy induced renal tubular damage was significantly higher in the radioactive iodine fifth day group (RI-5) when compared with the Sham group (p=0.01) and Amifostine group (p=0.01).Conclusions: A marked ablative radioiodine-131 induced renal toxicity was seen at fifth day of the therapy after a single RIT application and the main histopathological change was tubular damage. Amifostine have protective effects against ablative radioiodine-131 therapy and this effect is significant at fifth day of the therapy.

Background and Aims: The purpose of the study was to determine for the first time the effects of a weight loss diet with or without exercise on body fat levels and other anthropometrical characteristics in overweight and obese Cypriotadults.Methods: Three hundred and thirty seven overweight and obese subjects were assigned randomly to either a diet only (DO) or diet and exercise group (DE) for an 18-week period. Both groups received an energy reduced diet of 1500 ±200 Kcal. Furthermore, the DE group received specific dietary and activity guidelines involving a moderate intensity activity level included any of the following 3 criteria of ACSM guidelines and behavior modification consultation. All data analyses were performed by using the SPSS(v. 16.5) and the level of statistical significance was set at p < 0.05.Results: No significant differences were observed in both DO and DE groups during baseline period. During the intervention period weight, BMI and WC decreased significantly in DO group (p<0.001). In addition, body fat levels were found to be significantly reduced (p<0.001) in the DE group compared with the DO group. In multiple regression analysis Body fat levels were independently associated with weight (Beta: 0.569, 95%CI: 0.157-1.296, P<0.001) BMI (Beta: 0.295, 95%CI:0.088-1.214, P<0.01) and WC (Beta:0.206, 95%CI:0.095-0.954, P<0.001) after adjustment of age and gender.Conclusions: Despite the reduced effects of diet alone on body weight, BMI and WC, combining a reduced diet with exercise improves also BF levels which may have important benefits on several diseases later in life.

Background: Intracerebroventricular (ICV) experimental route is highly promising due to immediate approach of a "therapy" to the cerebrospinal compartment. Ischemic edema causes structural dislocations and stereotaxia alterations after temporary Middle Cerebral Artery Occlusion (t-MCAO), while there is no similar study for intracerebroventricular (ICV) invasion after permanent MCAO (p-MCAO).Methods: Male Wistar rats were subjected to right p-MCAO and clinically evaluated 6 and 18 hours post-occlusion, using the modified Neurological Stroke Scale (mNSS) and modified Bederson's Scale (mBS). Infarction volume, hemispheric edema, middle line dislocation and stereotaxia of the lateral ventricles were studied at the same time-points.Results: P-MCAO induced mild but significant changes in the stereotaxia of the infarcted (ipsilateral) lateral ventricle on 18- (P<0.05), though not 6-hours (P>0.05) post-occlusion. These changes correlated with the mNSS and mBS scores (P<0.01) and allowed the expression of linear mathematical equations (stereotaxic coordinate = b0 + b1*mNSS; calculated by regression analysis) predicting the new ventricular position in each individual animal. The contralateral ventricular system was structurally unaffected on both time-points. Verification experiments indicated that the new coordinates were necessary on 18-hours post-occlusion for successful ICV invasion in all p-MCAO rats (Number Needed to Treat 2.28), compared to 56.25% success when using the classical coordinates for normal rats.Conclusions: P-MCAO causes relatively late but predictable stereotaxia shifts for ICV invasion, which are different compared to t-MCAO.

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adolescents. Obesity is a major risk factor for NAFLD; however, it has been shown that NAFLD is not rare in nonobese adults. The aim of this study was to determine the prevalence of NAFLD in obese and non-obese children and adolescents.Methods: The medical records of 340 subjects (aged 2-20 years) in whom autopsy was performed were retrospectively reviewed. Of those, 10 subjects were excluded due to insufficient data. The remaining 330 subjects were included in the study, of whom 264 were normal weight and 66 were obese. All liver biopsy sections were evaluated by two pathologists in a blinded fashion.Results: The prevalence of fatty liver was 6% among all the subjects and was higher in the overweight group than in the normal-weight group (10.6% vs 4.9%; p<0.001). The prevalence of NAFLD increased concomitant with age. There was no significant difference between sexes in cases with NAFLD. Simple steatosis was detected in 7 subjects. Steatohepatitis was determined as type 1 in 5 subjects, type 2 in 7 subjects, and as overlap in 1 subject.Conclusions: This study demonstrated that NAFLD is an important public health problem not only in obese but also in non-obese children and adolescents. This suggests that whereas obesity may be a risk factor, other pathogenic factors may exist that could contribute to the NAFLD.

Background and aim: Induction with anti-thymocyte globulin (ATG) during solid organ transplantation is associated with an improved clinical course and leads to prolonged lymphopenia. This study aims to investigate whether prolonged lymphopenia, caused by ATG induction, has an impact on patient and graft survival following liver and kidney transplantation.Patients and Methods: This was a single-center, retrospective study. A total of 292 liver and 417 kidney transplants were performed with ATG induction (6 mg/kgr, divided into four doses), and the transplant recipients were followed for at least three months. The average lymphocyte count for the first 30 days after the operation was calculated, and the cutoff value for defining lymphopenia was arbitrarily set to ≤ 500 cells/mm³.Results: There were 210 liver transplant recipients (71.9%) who achieved prolonged lymphopenia, whereas the remaining 82 recipients (28.1%) did not. The mean survival time of these patient groups was 10.27 and 12.71 years, respectively (p = 0.1217), and the mean graft survival time was 8.98 and 12.25 years, respectively (p = 0.0147). Of the kidney transplant patients, 330 (79.1%) recipients achieved prolonged lymphopenia, whereas the remaining 87 (20.9%) did not. The mean survival time of these patient groups was 13.94 and 14.59 years, respectively, (p = 0.4490), and the mean graft survival time was 11.84 and 11.54 years, respectively (p = 0.7410). Conclusion: The efficacy and safety of ATG induction partially depend on decreased total lymphocyte counts. Following ATG induction in liver transplant recipients, a reasonable average lymphocyte count during the first postoperative month would be above 500 cells/mm³.

Pancreatic pseudocyst in children due to abdominal trauma is a rare entity. We report a 14-year-old boy suffering from acute pancreatitis due to blunt abdominal trauma that occurred during a football game, and resulted in a large pseudocyst formation. The child was treated conservatively for the post traumatic acute pancreatitis for 4 weeks and thereafter he was followed up for another 2 weeks. At the end of the 6 weeks after the first insult, the child underwent an open cystgastrostomy. Postoperative course was uneventful and the child was discharged on the 6th postoperative day.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma that mainly arises in the upper aerodigestive tract. The tonsil is a rare site of BSCC development and only fourteen cases have been reported in the international literature. We report here on the case of a 56-year-old man who presented with mild dysphagia. Computed tomography and examination of the oropharynx revealed a suspicious-looking, bulky mass on the right tonsil. Histopathological examination confirmed the presence of BSCC. The patient had cervical lymph node metastases and pulmonary metastases and was treated with chemotherapy and concurrent radiation. Despite the metastases the patient is still alive 3 years after the initial diagnosis.

Complications following unicompartmental knee arthroplasty (UKA) include aseptic loosening, polyethylene wear, arthritis progression and periprothetic fractures. We report on a patient with a firmly fixed, sizeable cement extrusion into the posteromedial aspect of the knee after a UKA causing impingement and pain in full extension. Cement extrusion is an extremely rare but potentially disabling complication that may occur despite care to remove all cement following implantation of the prosthesis. Removing a cement fragment, especially when this is firmly fixed to difficult-to-visualise and access parts of the prosthesis, is challenging. We believe the patient we report is the first one where a firmly fixed, sizeable cement extrusion was removed arthroscopically from the posterior aspect of the knee. This was achieved via an anterolateral portal with trans-notch view, combined with a posteromedial portal used both for viewing and instrument insertion. Arthroscopic removal of the impinging cement with the technique described above is a safe and effective option for the treatment of this difficult albeit rare problem.

Background: The competitive GH receptor antagonist pegvisomant is reported to normalise IGF-1 levels in up to 97 % of acromegalic patients at a maximum dosage of 40 mg/d.Description of Case: We present an acromegalic patient resistant to the recommended maximum GH receptor antagonist dosage. The 60-year-old male patient presenting with typical clinical signs of acromegaly has underwent multiple transsphenoidal surgeries and pituitary irradiation, while currently available pharmacological therapies for acromegaly have been exhausted.Results: Biochemical control of the disease could only be achieved until uptitration of pegvisomant to 60 mg/d which was tolerated well.Conclusions: The current treatment algorithm for acromegaly should be modified to treat cases of persistent and uncontrolled disease.

Trimethylaminuria (fish malodour syndrome) is a rare genetic metabolic disorder presented with a body odour which smells like a decaying fish. This odour is highly objectionable, that can be destructive for the social, and work life of the patient. Trimethylamine is derived from the intestinal bacterial degradation of foods that are rich of choline and carnitine. Trimethylamine is normally oxidised by the liver to odourless trimethylamine N-oxide which is excreted in the urine, so, uremia may worsen the condition. Uremia itself may cause more or less unpleasant odour. Poor uremic control may worsen the odour. We reported this case because Trimethylaminuria is not usually considered in the differential diagnosis of malodour in chronic renal failure and it is the first case that shown the association with Trimethylaminuria and chronic renal failure in the literature.

Although lymphomas involving the prostate gland are rare, they should always be considered in the differential diagnosis. We report a case of primary prostatic NHL in a 70-year-old man presented with hematuria and urinary obstructive symptoms. Routine laboratory tests were within normal limits and prostate-specific antigen (PSA) was 0,01 ng/ml. The patient underwent radical prostatectomy. Histologically, two different coexisting patterns of non-Hodgkin lymphoma, infiltrating the prostatic tissue, were identified. The diagnosis of diffuse large B-cell lymphoma (DLBCL)\ presenting with an associated low-grade lymphoma of MALT-type was confirmed by immunohistochemistry. The patient received chemotherapy without any complication and has been followed-up for 2 years since surgical resection with no recurrence. The clinicopathologic characteristics of prostatic lymphomas are discussed, while reviewing the current English-language literature.

A Pseudomonas oryzihabitans clinical isolate was recovered from a blood sample. The patient, a 14-year-old-adolescent underwent parathyroidectomy due to secondary hyperparathyroidism. The patient had been going peritoneal dialysis because of chronic renal failure. According to the susceptibility testing conducted with phenotypic methods the microorganism was sensitive to the vast majority of the antibiotics. The isolation of this rare species of Pseudomonas combined with the patient's medical history stimulated as to focus on the causes of the bacteremia, which was non catheter-related.